Saving N.J. taxpayer money by pre-empting health problems: Opinion

The goal of this pilot program is to help employees control their condition and better manage health care costs.

The goal of this program is to increase employees' access to care and information that will help them control their condition and better manage the costs of their health benefits coverage.Patrick T. Fallon/Bloomberg

By Linda Stender

For finding a way to help inner-city residents receive better health treatment at lower cost, Camden physician Jeffrey Brenner richly deserved the “genius” grants he received last week. One of his findings — that 1 percent of the city’s hospital patients were responsible for 30 percent of the costs — is staggering.

Hopefully such astonishing figures can give momentum to Assembly-approved bipartisan legislation I sponsored (A1214) with Assemblyman Jay Webber (R-Morris) to establish a pilot program to encourage better health care practices by public employees with chronic health conditions.

The bill would create a three-year pilot program to provide benefits coverage to employees with chronic health conditions. Diabetes, high cholesterol, hypertension and asthma would be targeted. Chronic disease accounts for more than 75 percent of the $2 trillion spent on medical care nationally each year.

We would start with public workers because they’re the ones whose benefits the state directly controls. This program would use financial incentives to increase the employee’s interaction with health care providers and encourage use of health benefits that will specifically address and improve his or her chronic health condition. That, in turn, should benefit taxpayers.

The goal of this program — based on a program developed in Asheville, N.C. — is to increase employees’ access to care and information that will help them control their condition and better manage the costs of their health benefits coverage. That should bring taxpayer savings that will benefit everyone.

A committee would be charged with selecting eligible employees based on their chronic health conditions to participate in the pilot program. Participation in the pilot program is voluntary. Employees who choose to participate in the program would be offered the following incentives directly related to the diagnosis, care or treatment of the condition:

• All tuition costs for any education class attended by the employee that provides medical condition self-management, recommended to the employee by the primary treating physician or assigned pharmacist.

• All costs for private visits with the employee’s assigned pharmacist.

• All costs for a medical device or supply deemed necessary by the primary treating physician or assigned pharmacist.

• All laboratory testing shall be covered.

• All copayments for any prescription drug will be waived.

To remain a participant in the pilot program and receive these financial incentives, the employee must comply with all aspects, including attendance at all medical appointments, adherence to advice or instructions provided by the primary treating physician or assigned pharmacist and use of all prescription drugs as directed.

Asheville’s experience shows the program works. The results there found employers saving $918 per participant, with absenteeism cut 50 percent, workers’ compensation claims reduced and employee satisfaction high. Taking their medicine and seeing their health care professionals meant fewer trips to the emergency room and shorter hospital stays. That reduces pain and suffering and saves money.

The savings should cover our bill’s upfront costs, which we would determine through the pilot program. After all, pilot programs are established to estimate the potential fiscal impacts of programs before they are implemented on a large-scale basis. The savings can be dramatic. We need to know whether it will work here.

When the pilot program here is over, the governor and the Legislature would receive a detailed summary of the program and recommendations for extension, modification or expansion of the program. If, as expected, this saves money, extending and expanding the program should be a no-brainer, especially because this isn’t a partisan matter. For instance, Assemblyman Webber and I disagree on almost every issue, but this idea is just plain common sense.

We’re going to be seeing a lot of changes in health care in the coming years, but one thing we cannot do is continue encouraging costly unhealthy behavior. It’s bad policy, and expensive. Every dollar counts, and this would be a smart and innovative approach to improve lives and save money for taxpayers.

Linda Stender is a Democratic assemblywoman representing the 22nd Legislative District in Middlesex, Somerset and Union counties.